Factors associated with candidemia caused by non-albicans Candida species versus Candida albicans in the intensive care unit
Factors associated with candidemia caused by non-albicans Candida species versus Candida albicans in the intensive care unit
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DOI：
10.1086/529435
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发表时间：
2008-04-15
影响因子：
11.8
通讯作者：
Hadley, Susan
中科院分区：
文献类型：
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作者：
Chow, Jennifer K.;Golan, Yoav;Hadley, Susan
背景白色念珠菌一直是重症监护病房（ICU）中真菌血流感染（BSI）的最常见原因;然而，由于非白色念珠菌属的感染患病率一直在增加。我们研究了与非白色念珠菌引起的BSI相关的因素，并与念珠菌进行了比较。白色念珠菌BSIs，在ICU患者人群中。在我们的病例对照研究中，我们确定了连续的成人ICU患者因非白色念珠菌或念珠菌引起的BSI。1995-2005年期间，2家三级保健医院的白色念珠菌感染率。收集的数据包括人口统计学特征、合并症、抗生素和抗真菌药暴露以及ICU相关因素，如全肠外营养、血液制品输注、侵入性操作、中心静脉导管使用、血液透析和机械通气。我们建立了一个多变量逻辑回归模型，该模型确定了区分非白色念珠菌引起的BSI和念珠菌引起的BSI的变量。albicans.Results. 67例患者因非白色念珠菌引起的BSI，79例患者因念珠菌引起的BSI。白色念珠菌BSIs根据风险时间调整变量。在多变量模型中，与念珠菌相比，与非白色念珠菌引起的BSI风险增加相关的因素。白色念珠菌BSI包括氟康唑暴露（比值比，11.6; 95%置信区间，2.28-58.8）、中心静脉导管暴露（比值比，1.95; 95%置信区间，1.10-3.47）和每日抗生素平均使用次数（比值比，2.31; 95%置信区间，0.71-7.54）。与念珠菌相比，全胃肠外营养暴露与非白色念珠菌引起的BSI风险降低相关（比值比，0.16; 95%置信区间，0.05-0.47）。白色念珠菌BSIs两组患者在ICU的住院时间无显著差异。特异性抗生素，如万古霉素和哌拉西林-他唑巴坦，与非白色念珠菌引起的BSI无关。与念珠菌引起的BSI相比，接受氟康唑和中心静脉导管暴露与非白色念珠菌引起的BSI风险增加相关，全肠外营养与非白色念珠菌引起的BSI风险降低相关。白色念珠菌无非白色念珠菌感染特征的患者可从氟康唑经验性抗真菌治疗中获益。
Background. Candida albicans has been the most common cause of fungal bloodstream infections (BSIs) in intensive care units (ICUs); however, infections due to non-albicans Candida species have been increasing in prevalence. We examined factors associated with BSIs due to non-albicans Candida species, compared with C. albicans BSIs, in an ICU patient population.Methods. For our case-comparator study, we identified consecutive adult ICU patients with BSIs due to non-albicans Candida species or C. albicans at 2 tertiary care hospitals during the period 1995-2005. Data collected included demographic characteristics, comorbidities, exposure to antibiotics and antifungals, and ICU-related factors, such as total parenteral nutrition, blood product transfusions, invasive procedures, central venous catheter use, hemodialysis, and mechanical ventilation. We built a multivariable logistic regression model that identified variables that differentiate BSIs due to non-albicans Candida species from BSIs due to C. albicans.Results. There were 67 patients with BSIs due to non-albicans Candida species and 79 patients with C. albicans BSIs. Variables were adjusted for time at risk. In multivariable models, factors associated with an increased risk of BSIs due to non-albicans Candida species, compared with C. albicans BSIs, included fluconazole exposure (odds ratio, 11.6; 95% confidence interval, 2.28-58.8), central venous catheter exposure (odds ratio, 1.95; 95% confidence interval, 1.10-3.47), and mean number of antibiotics per day (odds ratio, 2.31; 95% confidence interval, 0.71-7.54). Total parenteral nutrition exposure was associated with a decreased risk (odds ratio, 0.16; 95% confidence interval, 0.05-0.47) of BSIs due to non-albicans Candida species, compared with C. albicans BSIs. Duration of stay in the ICU was not significantly different between the 2 groups. Specific antibiotics, such as vancomycin and piperacillin-tazobactam, were not independently associated with BSI due to non-albicans Candida species.Conclusions. Receipt of fluconazole and central venous catheter exposure were associated with an increased risk of BSI due to non-albicans Candida species, and total parenteral nutrition was associated with a decreased risk of BSI due to non-albicans Candida species, compared with BSI due to C. albicans. Patients without characteristics of infection due to non-albicans Candida species might benefit from empirical antifungal therapy with fluconazole.